Oh dear, the new Joint Clinical Commissioning Committee have not answered questions from members of the public that we asked over a month ago. I have written to remind them we are still waiting. If you would like to remind them too, here is the email address.
On 4th July, the new Committee met for the first time, bringing together 11 Clinical Commissioning Groups’ Chief Officers and Governing Body Chairs from across West Yorkshire and Harrogate.
The Joint Committee will decide what health services to buy for the region’s Sustainability and Transformation Partnership, while cutting West Yorkshire and Harrogate’s NHS and social care spending by over £1bn by 2020/21 and simultaneously improving the quality of care and patients’ health.
Bit of a conundrum there.
Our questions were about Hyper Acute Stroke Services cuts and centralisation, how the Committee works and what it is going to do.
Draconian £1bn+ NHS and social care cuts for West Yorkshire & Harrogate
Despite being a non-statutory body – ie it is not mandated by law – the Joint Clinical Commissioning Committee is claiming statutory powers for itself. At the 4th July meeting, Dr Gordon Sinclair from Leeds Clinical Commissioning Group said the Joint Committee is not an advisory group to the Sustainability and Transformation Partnership, but part of it – adding:
“Clinical Commissioning Groups are statutory decision making bodies and have organised themselves into the Joint Clinical Commissioning Committee – they will be making statutory decisions in this JCCC.”
Doing things this way avoids regulatory or statutory changes to the way the NHS is run – which would require MPs to scrutinise and vote on the proposed changes.
But legal advice obtained by City and Hackney Clinical Commissioning Group in North East London, that clinical commissioning decisions made by way of ‘collaboration’ cannot be binding on the partners nor can decisions be made by majority vote.
Spinning so fast they must be dizzy
The quangos, the Conservative government and most of the health think tanks are spinning the Sustainability and Transformation Partnerships as a solution to the widely acknowledged failings of the 2012 Health and Social Care Act – which had no democratic mandate as it was not in any party’s 2010 election manifesto.
As if. If the Sustainability and Transformation Partnerships go ahead, they will terminally dismantle the national health service into 44 local health services run as private/public partnerships with no duty to provide a comprehensive, universal health care.
The 2012 Act removed that duty from the Secretary of State and handed over responsibility to local clinical commissioning groups that, as Calderdale Clinical Commissioning Group’s Chief Officer’s Annual Report for 20167/17 states, only have to:
“arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population.”
These local quangos are obliged to buy health services for their area through competitive tendering that is open to private sector health companies.
The localisation of the formerly National Health Service handily allows blame to fall on local doctors and bureaucrats when it all goes wrong – and how can it do otherwise, when it is subject to the current cuts and stealth privatisation agenda? That’s the whole purpose of that agenda.
This undemocratic 2012 Health & Social Care Act is now being bypassed by the even more undemocratic Sustainability and Transformation Partnerships, without any new legislation being put forward for democratic scrutiny by Parliament and the public. Underhanded doesn’t begin to describe the process.
The 2017 Conservative manifesto said if necessary it will bring in legislative changes in order to carry out the Sustainability and Transformation Plans, but in the meantime it will make non-legislative changes to “remove barriers” to them.
The Labour opposition should be taking advantage of the government’s weakness to push for the 2012 Health and Social Care Act to be repealed and replaced with the NHS Reinstatement Bill, as its priority Private Members Bill.
Is this Joint Committee even lawful?
As this Joint Clinical Commissioning Committee is not a statutory body – but all its member Clinical Commissioning Groups are statutory bodies – how is it legal for the Joint Committee to make decisions that override the power of its member Clinical Commissioning Groups to disagree with them? Because this is what its Memorandum of Understanding says it can do.
I asked these questions at the Calderdale Clinical Commissioning Group AGM on Thursday 10th August:
- What legal advice, if any, has Calderdale CCG obtained about the legality of West Yorkshire and Harrogate STP JCCC decisions – made either by consensus or majority vote, or failing that, by a resolution brokered either by NHS England or a third party mediator – that according to the MoU are binding on all JCCC “parties” – ie the member CCGs?
- Is Calderdale CCG aware that legal advice obtained by City and Hackney CCG makes it clear that clinical commissioning decisions made by way of ‘collaboration’ cannot be binding on the partners nor can decisions be made by majority vote?
The Calderdale Clinical Commissioning Group’s Annual Report 2016-17 says the Joint Committee currently has no decision making powers in relation to resource allocation. But I can’t see that anywhere in the Memorandum of Understanding.
There will be issues in this Joint Clinical Commissioners’ Committee where one NHS area has to fight against other NHS areas, because by 2020/21, the WYH STP will have had to cut over £1bn NHS and social care spending, compared with what it would have spent by then, if this harsh financial control hadn’t been imposed.
Sidelining local authorities and social care
Sustainability and Transformation Plans/Partnerships are supposed to be about the integration of health and social care. Social care is the responsibility of local authorities, and under the Better Care Fund, local authorities and clinical commissioning groups have joint/integrated commissioning responsibilities. But there are no Councillors or local authority officers on the Joint Clinical Commissioners’ Committee.
Asked about that at the 4 July meeting, Jo Webster (the Wakefield Clinical Commissioning Group Chief Officer) said:
“That’s an important question. Local Authorities are an important part of the STP. They are included in the way in which we make decisions and bring decisions back to this committee.”
The next day, the Local Government Association announced that a survey of councils with social care responsibilities showed that only a fifth of councils think the Sustainability and Transformation plans will succeed. There were widespread complaints that the NHS has excluded Councillors from the planning process.
Ninety percent of councillors who responded said that the process had been driven from Whitehall rather than locally. More local authorities believed the process was harming social care than helping it.
Councillors’ comments included:
“The way in which the STP has been handled (top down, secretive, lack of engagement) has harmed relationships between the council and some NHS colleagues.”
“It is entirely driven from the top, via budget pressures. The process has been overly secretive and opaque. It has got in the way of closer working between councils and health.”
What are our elected Councillors doing to stop this undemocratic process of slashing our NHS? Here is a template letter to ask them this question. [Link coming soon].
UPDATE 15 August 2017 – String vest award to Jo Webster for answers that are full of holes.
The communications officer at Wakefield Clinical Commissioning Group has sent their answers to our questions – but three of my questions (7, 8 and 9) have not been answered in the Q&A pdf they sent and their answer to my question 3 was incomplete.
Are the Joint Clinical Commissioning Committee’s decision-making and disputes-resolution processes lawful?
Questions 7, 8 and 9 are about which organisation makes the decisions about the hyper acute stroke services cuts, whether the decision making processes are lawful and whether the dispute resolution processes are lawful.
It’s all very well Dr Gordon Sinclair from Leeds Clinical Commissioning Group to say at the 4th July meeting that:
“Clinical Commissioning Groups…will be making statutory decisions in this JCCC.”
Because it’s not at all clear that statutory decisions that are binding on individual CCGs can be made either by the Lead Commissioner/Contractor (which they explained means a Lead Commissioner that may also carry out contracting duties), or by the Joint Clinical Commissioning Committee.
How can one Clinical Commissioning Group have statutory powers over other Clinical Commissioning Groups which have equal statutory powers?
And how can a Committee with no statutory existence or powers, exercise decision making and disputes resolution powers over bodies – the clinical commissioning groups – that do have a statutory existence and powers?
Both these processes are accepted in the Memorandum of Understanding, which therefore looks like a rather dodgy document that needs explaining.
But they’ve not answered the question about which organisation makes the decisions about the hyper acute stroke services cuts, nor the two that aim to:
- find out how the Joint Clinical Commissioning Committee is accountable to individual member CCGs if it makes decisions that are binding on them, and
- clarify what powers the individual CCGs delegate to the Joint Committee when the Joint Committee makes decisions that are binding on them – and also when the dispute resolution processes kick in, to sort out disagreements about these binding decisions.
I have replied asking Jo Webster to answer questions 7, 8 and 9 as well as the questions below, arising from their incomplete answer to my question 3. This didn’t just ask about the public availability of STP detailed finance information, I also asked for detailed workforce and efficiency savings information.
a) Will these documents also be published in September?
b) And why has it taken this long to publish them? Given that in January, as my question 3 explains, Jo Webster told the West Yorkshire and Harrogate Joint Health Scrutiny Committee meeting that all these documents containing detailed information about the STP would be made public once negotiations and contracts with NHS England were concluded.
c) Surely that was completed by the end of last financial year, so why were they not published then?